Despite knowledge that hypertension is a major risk factor for heart failure, it is unclear why some individuals with hypertension develop the heart failure syndrome while others do not. Since abnormalities in cardiac mechanics occur during the progression from hypertension to heart failure, understanding the determinants of abnormal cardiac mechanics in hypertension is a critical unmet need. Sensitive echocardiographic indices (myocardial tissue velocities, strain, and non-invasive pressure-volume analysis) can provide insight into cardiac mechanics in large epidemiologic studies. We propose to use state-of-the-art speckle tracking analysis to quantify cardiac mechanics in the Hypertension Genetic Epidemiology Network (HyperGEN) Study of the Family Blood Pressure Program (FBPP). By studying cardiac mechanics in a population-based epidemiologic study, we aim to: (1) determine the acquired risk factors for abnormal cardiac mechanics in hypertension; (2) determine heritability of systolic and diastolic cardiac mechanics in African Americans and whites; and (3) identify novel genetic loci associated with abnormal cardiac mechanics in a genome-wide association study with replication in the Coronary Artery Risk Development in Young Adults (CARDIA) Study and the Hutterite Family Health Study. We anticipate that results from this study will: (1) provide greater understanding of risk factors for the development of abnormal cardiac mechanics in hypertension; and (2) lead to a breakthrough in the understanding of the molecular pathways which dictate the transition between hypertension, hypertrophy, and heart failure. PUBLIC HEALTH RELEVANCE: Hypertension is the most common risk factor for heart failure, and both hypertension and heart failure are major public health problems which cause substantial morbidity and mortality. It is therefore important to improve understanding of why some individuals with hypertension develop heart failure while others do not. Since abnormal cardiac mechanics in hypertension lead to the heart failure syndrome, determining the acquired and genetic factors associated with abnormal cardiac mechanics in this epidemiologic study will provide novel insights into the pathogenesis of heart failure in hypertension and may ultimately identify novel therapeutic targets for the prevention and treatment of hypertensive heart disease.